*Thanks to Mr. Stewart Leavitt for allowing us to use this profile he did at AT Forum. It was written a little more than a year ago....was personally approved and liked very much by Dr. Dole. Mr. Leavitt will also be doing a personal followup in their Summer edition of AT Forum.
Vincent Dole, MD, has been acknowledged worldwide as the “founding
father” of methadone maintenance treatment (MMT) for opioid addiction. Yet, he
is always quick to acknowledge the contributions of the research team he put
together at The Rockefeller University in the mid-1960s to develop MMT.
From Math to Medicine
Dole was born in 1913 and raised on the north side of
Chicago, Illinois. He attended Culver Academy, a private college preparatory
school in Indiana, and then went on to major in mathematics at Stanford
University – graduating in 1934.
He decided to pursue a medical career but had not
taken some of the required premedical courses. By the end of his second year at
the University of Wisconsin, where he went to pursue the necessary science
courses, he was accepted into Harvard Medical School, from which he graduated in
During his medical internship and residency at
Massachusetts General Hospital, Dole developed a special interest in metabolic
diseases. In 1941, he joined the faculty of The Rockefeller University in New
York City to conduct research on hypertension, lipid metabolism, and obesity.
A Fortunate Discovery
In the early 1960s, Dole had an opportunity to assess
the health care needs of New York City and concluded that a major problem there,
and elsewhere around the country, was heroin addiction. However, at the time,
treatments for heroin addiction – largely based on forced detoxification and
drug-free behavioral therapies – were remarkably unsuccessful.
He decided to redirect the efforts of his
research to address opioid addiction. Shortly thereafter, Dole recruited Marie
Nyswander, MD, and then Mary Jeanne Kreek, MD, as key members of his research
team. To this day, he especially recognizes the contribution of Nyswander in
teaching the team about drug addiction and the importance of listening to the
patients. (She was featured in the Winter 2005 edition of AT
After first unsuccessfully testing short-acting
opioid medications, the team discovered that longer-acting methadone provided
the qualities they were seeking. It was orally administered, stemmed withdrawal
and drug craving, did not induce opioid tolerance, and blocked effects of
illicit opioids if any were taken. They published their first research findings
in 1965, reporting on 22 patients, in the Journal of the American Medical
As an explanation for methadone’s usefulness, Dole
proposed that there is a physiologic basis for heroin addiction involving
altered metabolic processes and irreversible changes in brain chemistry.
Methadone helps “normalize” those functions; however, for most patients daily
methadone could be required for a lifetime, much like insulin is for
controlling, but not curing, severe diabetes.
In essence, they focused on opioid addiction as a
medical condition, rather than as a character defect,
moral failing, or behavioral disorder as had been so commonly believed in the
past. Perhaps, Dole’s greatest contribution to the field has been the concept
that, despite whatever other troubles an opioid-addicted patient may have – of
which there might be many, including mental, social, and economic problems –
addiction is first and foremost a brain disease that
can benefit from pharmacologic intervention.
Dole once commented, “The interesting thing about
methadone treatment is that it permits people to become whatever they
potentially are.” MMT has demonstrated that so-called “addict traits” are a
consequence, not a cause, of addiction and that substantial numbers of
opioid-addicted individuals can be rehabilitated to become productive members of
Enduring Passion for Science
One of Dole’s enduring qualities is his open-minded
interest in new treatment approaches, albeit tempered by an insistence on sound
research evidence. He has acknowledged that methadone is but one medication and
other medical treatments for opioid addiction may be worthy of consideration.
However, none of them to date has demonstrated superiority over methadone in
well-documented clinical trials.
He candidly criticizes the ignorance of fellow
physicians who close their minds to the disease concept of addiction. And, he
has had little tolerance for those claiming that methadone merely substitutes
one addictive drug with another, or touting alternative addiction treatment
therapies that do not have a firm footing in science.
In the tradition of “listening to patients,” Dole has
been a strong supporter of methadone-patient advocacy groups. He has emphasized
that involved patients with legitimate concerns for how they are being treated
can bring about real changes that are otherwise difficult to achieve within the
More Rational Attitudes
Through the years, Dole has been a prolific writer
and frequent speaker on addiction and MMT. He has received many honors and
awards for his work, including the prestigious Lasker Award in 1988.
He told AT Forum nearly a decade ago, “My
job always has been to promote the question: What can be done about addiction?”
He believed that experience and the truth would bring us to more rational ways
of dealing with addiction treatment, and that rather medieval attitudes toward
addiction would be overcome in favor of viewing it as a medical disease.*
As this present article was being developed, Dole was
recovering from a series of debilitating strokes. Asked if he had some thoughts
about the status of MMT today, he said, “I would love to believe that the
medical profession has come to accept addiction as a medical problem. That would
be my dream. However, there is still so much ignorance and prejudice that it
“MMT has exceeded my expectations in terms of its
success and its demonstrated positive results; it is surprisingly useful if one
believes in addiction as a disease,” he continued. “On the other hand, if one is
trying to disprove that methadone works, and inadequate methadone doses are
used, failure is almost certainly guaranteed.”